Abstract
Nil per os (NPO) is the traditional postoperative approach for patients undergoing abdominal surgery. Data have shown that withholding oral intake in patients undergoing colorectal, gynecologic, urologic and vascular surgery is unnecessary; however, NPO is still widely practiced in patients undergoing major upper gastrointestinal surgery. In this Practice Point commentary, I discuss the findings and limitations of a study by Lassen and colleagues, which investigated the impact of routine NPO with enteral tube feeding compared with allowing normal food at will in patients undergoing upper gastrointestinal surgery. The results revealed that allowing normal food at will after surgery did not increase morbidity, and that a lower number of complications were associated with this approach. I hope that these findings will encourage fellows and residents not to be hidebound by their clinician colleagues' attitudes and approaches that have not changed in 25 years. The NPO approach is unnecessary in patients undergoing upper gastrointestinal surgery.
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References
Begg CB et al. (1998) Impact of hospital volume on operative mortality for major cancer surgery. JAMA 280: 1747–1751
Fong Y et al. (1996) Drainage is unnecessary after elective liver resection. Results of a randomized trial. Am J Surg 171: 158–162
Conlon KC et al. (2001) Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg 234: 487–494
Jung B et al. (2007) Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection. Br J Surg 94: 689–695
Brennan MF et al. (1994) A prospective randomized trial of total parenteral nutrition following major pancreatic resection for malignancy. Ann Surg 22: 436–444
Heslin MJ et al. (1997) A prospective randomized trial of early enteral feeding after resection of upper GI malignancy. Ann Surg 226: 567–580
Lindenauer PK et al. (2005) Perioperative beta-blocker therapy and mortality after major noncardiac surgery. N Engl J Med 353: 349–361
POISE Study Group (2008) Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 371: 1839–1847
van den Berghe G et al. (2001) Intensive insulin therapy in the critically ill patients. N Engl J Med 345: 1359–1367
Brunkhorst FM et al. (2008) Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 358: 125–139
Brennan MF (1981) Total parenteral nutrition in the cancer patient. N Engl J Med 305: 375–382
Lassen K et al. (2008) Allowing normal food at will after major upper gastrointestinal surgery does not increase morbidity. A randomized multicenter trial. Ann Surg 247: 721–729
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Brennan, M. Is nil per os still appropriate for patients undergoing upper gastrointestinal surgery?. Nat Rev Gastroenterol Hepatol 5, 660–661 (2008). https://doi.org/10.1038/ncpgasthep1279
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DOI: https://doi.org/10.1038/ncpgasthep1279
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